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Sunday, January 25, 2009

Put A Bandaid On It

I'm watching what exactly they treat a friend's injury with and for, and comparing that sitch with my own and 2 other people's disability processes. Four of us have motor functioning issues as well as pain and site-specific joint and spinal problems.

He is the second medical field worker I've watched, too. I assumed that medical folks would be treated better than laymen by their own, and to an extent that's true. They are, in my experience, given total pain relief from the beginning. He was given the same drugs, in the same order as I was. But he was given narcotics right from the beginning, where I didn't receive them for years. And he was given higher doses from the beginning. He can call his narcotic script in, where I have to have someone pick it up and fill it.

However, that seems to be the end of special treatment. As in my case, where only surgeries will change anything (and they won't do it til I'm 60), they are saying the same treatment course I took should be his course. Namely, steroid shots, antiinflams and narcotics and then surgery. (Though they'll operate on him when he wants it, as they did the other med pro).

In short 4 of us are being treated for effects and never going near the cause. In my case, they know the problem but won't fix it. In other cases they don't really know what the problem is but want to go in and look. The other disabled folk I'm referring to have had surgeries but haven't been relieved of either condition nor pain. They are on a combo of drugs and have started to have complications from the drug use. But none of us are quantitatively better at all.

We have all undergone steroid shots, which are painful and do nothing, and actually can cause more damage. A nurse finally intervened in my then-Ortho surgeon's office, telling me I shouldn't have had so many cortisone shots as I'd had already. In research, the protocol says 4-6 and no more, as cortisone breaks down cartilege. I had either 8 or 9. Since I'd started with little cartilege to begin with, the cortisone removed what little I had left. Then I had lydocaine shot into the hip joint and the pain was numb for roughly 18 hours. While that was a pleasant change and it was nice to walk up a flight of stairs like a person, was it worth it? The procedure required a surgery room; though I only was given a local an anaesthetist was in on it. The doctor had a hard time getting the flexible, 6" needle around a hook that had formed on the edge of my femur. I watched the whole thing on a screen, with him. He was very nice, and apologized when he saw me crying from the pain. It took 3 times longer than he'd planned and I was numb in the leg from all the local shots the anaesthetist kept shooting me with to finish the deal. The next morning it was as if I hadn't had a shot at all, except for the huge bruises on my hip. All the pain plus some new from the needles and the interior efforts at getting into the joint.

The sum of our combined medical bills must exceed a million dollars. One of the group has had 14 surgeries around one nerve. His last neck surgery was a success only in that it didn't make him worse and he wasn't paralyzed, which was the risk. I've had more CT Scans, MRIs and x-rays than a person should have. Doctors have halted procedures in flagrante because other docs sent me back to radiology too soon. That's not a commonality to the others. However, each of us has been thru so many tests that availed doctors nothing that I have to wonder if the tests were necessary at all. It does seem to be the system they employ blanketly. But does it do anything else besides keep radiology busy and billing?

Ever have electrically charged needles pushed into your nerves to raise a noise on a machine? That's an EMG, an ElectroMiloGram. If you didn't have neuropathy before it, you will afterward, and for years. It's a pain you'll never forget, it will make you cry, it will change your outlook on life. It's what they use to measure nerve damage. There's no pain relief, barely a human element at all, as neurologists really aren't the warm type. But if you're being evaluated for any injury or unknown cause of pain, you'll probably be told to have one. Don't do it. You have the right to refuse. I consider it as barbaric as trepanning. Or waterboarding.

So is this just another rant without purpose? Well, yes and no. There's the point that though med pros may get a bit better care, they get the same carnival of souls treatment as the rest of us down the line. So where's the real dividing line in treatment? It's pretty apparent to me that it's economical.

For instance, I can cite 2 people who've needed hip replacements. 1 is an old acquaintance who's an importer with fabulous private insurance. The other is a local on Disability.

The importer had both hips replaced within 2 years and never lost a day to being disabled, as they replaced his hips at the first signs of degeneration. The first hip healed within 2 months after surgery and he was back traveling; on a cane for a while, but getting around nonetheless.. The second hip healed a little more slowly but he still lost only a couple additional weeks to PE before he was taking off to Europe on a buying trip. He has full use of his legs and you'd never know he has total hip replacements.

The local lived for 6 years in pain, becoming more and more unable to walk. They gave her a cane, then a walker. They wouldn't give her a motorized chair. Eventually she became housebound, then bedridden. She became morbidly obese. Her mental and emotional states were horrible. People took advantage of her incapacity. To her, it was a choice of being ripped off or being alone. Finally, someone advocated for her and she got her hip replaced. However, they'd waited so long that her leg was 2 inches shorter than the other, too much of a difference to adjust the parts to compensate. So she has a limp and a lift. She also got minimal PE, and now, 2 years after the THR, she is still on a cane or walker and some days she can't walk until she's pumped on narcotics. She won't be going back to work. And she's nearly ten years younger than the importer. And me.

Yes, medical care is given, but it's certainly based on how much money you have. Hers is the most glaring example, but I know of many, many others. Right down to a retired policeman on Medicare, denied a prescribed third hormone shot due to the expense. Or the AIDS patient on Medicare, a flaming queen, who was told he was just panicking when he'd had a stroke. The overweight new mother on Medicaid, told she should go home and take some antacid and not eat so much, when her gallbladder was about to burst. I'm certain that poor patients are treated as second class citizens. I see and experience it all the time.

So how to adjust this? I'm not sure even SPH would fix this. The insurance companies won't go out of business, so private insurance will continue, and doctors will always go for the full dollar over the 86% or whichever Medicare/aid pays now. Perhaps it would make a difference if unions and large companies dropped BC/BS, GHI, etc. and joined the rest of the public in a national health system. With that large a consumer pool, they'd be hard pressed to give poor care to those who have an option and aren't poor. In fact, the doctors' office staffs could no longer say "Medicaid, right?" with a sneer. They wouldn't necessarily know the poor from the middle class.

All of this is not to say that you're treated like filth to your face. Most of the time there remains the stonefaced politeness everyone gets. Nurses most often are the most alert and concerned for patients' wellbeing. Personally, I've had nurses that were angels and nurses that should've worked at Gitmo. It's further up the chain that the prejudice really shows- in the nontreatment, in decisions left to the system rather than the patient. And while it continues, patients are more beaten down, nurses become sick and tired of the stress, good docs do what they can and shake their heads.

It was recently disclosed that several local doctors are being investigated because of all the money pharma companies have been paying them. The docs and drugs in question are all psych specialties.

I once lived with a young doctor. He and his friends all became docs for the money and prestige, and no bones about telling you that with a dismissive laugh. I'll spare you their horrifying other stories, all told with laughter.

Sorry, no answers, no happy ending. I just know that nobody talks about these things and I'm determined these facts get out there. It really is true that there are things you can't understand, things you may deny, until it happens to you or yours. But they are happening. It's just that nobody tells you. Why don't people talk? Fear. Especially in small towns, if a doc has a problem with you, your name will be Mudd. It's medical blackballing, and I know 2 people who've been denied treatment by new docs because of what the old doc said. It's corrupt, it's lousy and it's true.

So if you're monied, congrats and expect good med experiences. If you're poor, lower your expectations. And your life expectancy.